Atypical femoral fractures (AFFs) are a rare but serious complication of prolonged anti-resorptive therapy for osteoporosis. This study aimed to develop consensus-based recommendations for the clinical management of AFFs across the Asian Federation of Osteoporosis Societies (AFOS), for harmonizing practice and improving patient outcomes.A structured questionnaire covering ten key domains related to AFFs was distributed to expert representatives from the 10 AFOS member countries or regions. Responses were analyzed to identify areas of consensus and variation in regional practice. A concurrent narrative review of the literature was conducted to inform evidencebased recommendations. Survey responses were obtained from 8 of 10 participating AFOS member nations or regions. Among these, Thailand, Malaysia, South Korea, and Hong Kong reported established national guidelines or position statements on AFFs. Contributing risk factors include extended anti-resorptive therapy, femoral geometry, comorbidities, and specific pharmacologic exposures. Diagnosis depends on clinical suspicion and multimodal imaging, with high concordance in diagnostic criteria across regions. Screening emphasizes full-length femoral imaging in highrisk individuals. Incomplete AFFs are managed conservatively or with prophylactic fixation, while complete AFFs typically require intramedullary nailing, tailored to anatomic variations such as femoral bowing. Post-fracture care involves discontinuation of anti-resorptives, assessment for secondary osteoporosis, and potential initia tion of anabolic therapy, including teriparatide, abaloparatide, and romosozumab.This AFOS-led initiative highlights the importance for early detection, individualized management, and region-specific strategies. A multidisciplinary, patient-centered approach—encompassing risk assessment, im aging surveillance, surgical intervention, and tailored pharmacologic treatment—is crucial to reduce AFFs impact and improve skeletal health outcomes across Asia.

Objectives: The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). Methods: A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. Conclusions The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.